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Fifteen years of research into Vancouver’s needle and syringe programme leads to the conclusion that such programmes can stop the spread of HIV and do not increase harms. However, they can only be effective if their policies allow sufficient sterile equipment to be distributed to ensure injectors always have fresh supplies.
Thorough search for evidence uncovers 37 studies which overall suggest that by tackling sexual and injecting risk behaviours, some interventions protect against HIV in adults with a history of criminal justice involvement. Methadone maintenance emerged as the best established.
Lower-risk needle and syringe combinations seem acceptable to people who inject drugs in England, but given that a sudden change in equipment can be difficult to adjust to, their gradual introduction seems best, alongside an intervention to educate and support.
Strong evidence from two US cities that moving from a blanket prohibition on possession of equipment for injecting illegal drugs to providing this equipment via legal needle and syringe programmes prevented thousands of HIV infections, resulting in large savings in the treatment of these infections.
For people who share injecting equipment, ‘low dead space’ syringes may lead to a reduced risk of becoming infected with blood-borne viruses by limiting the volume of fluid that is drawn up but not injected. However, they may not (yet) be suitable for all types of injectors or injections.
Did Florida’s first needle exchange programme result in fewer items of used injecting equipment being left in public places? The answer comes from a walkthrough of Miami neighbourhoods and interviews with people who inject drugs before and after the programme opened its doors.
REVIEW 2003 PDF file 1150Kb
Hepatitis C and needle exchange part 1: The dimensions of the challenge
First part of the series established that hepatitis C has already infected a substantial minority of British injectors and is spreading rapidly due to continued risk behaviour allied with the robustness, infectivity and prevalence of the virus.
REVIEW 2003 PDF file 1826Kb
Hepatitis C and needle exchange part 2: case studies
Six case studies show how the complex balance of exchange services can be disrupted, leaving hepatitis C and HIV spreading rapidly. Common themes are resource starvation, local hostility, counterproductive restrictions and a non-interventionist ethic. Includes influential early studies dating from 1992.
REVIEW 2004 PDF file 784Kb
Hepatitis C and needle exchange part 3: the British record
Reveals the paucity of evidence that exchanges in Britain have directly reduced risk behaviour or infection spread, and the hidden flaw in the seminal pilot study. Lack of real impact is probably less the problem than lack of real evidence of impact.
REVIEW 2004 PDF file 1222Kb
Hepatitis C and needle exchange part 4: the active ingredients
Final part of the series pulls together the threads in the form of the limitations which threaten viral control and the practice ingredients which hold promise for the future. A revitalised agenda commensurate with the challenge of hepatitis C.
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